In the debate about the NHS reforms that occupied so much Twitter space before the Health and Social Care Bill was passed, Trish Greenhalgh quite properly challenged me to use the five whys approach that Taiichi Ohno used within Toyota and that I had been advocating be used for other issues, to drill down to the root of a problem, and to support my contention that reform was necessary. [1] more…

Reality is created by the language we use. Language creates reality rather than describing it; that is the consistent message from Ludwig Wittgenstein, Benjamin Lee Whorf, and John R Searle. If we want to change reality one way is to change the language used, and for this reason we ban, or try to ban, the use of the terms primary, secondary, acute, and community in the workshops we run, like the workshop with great participants from West Berkshire that was held on the 2 February. more…

“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured. more…

“All of a sudden a big mealie pudden came flying through the air.” This is the opening line of a Glaswegian song, which only gets worse, about an assault by a mealie pudden, a sort of second class black pudding with the blood removed.

On the 24 November at 11 o’clock, I experienced severe central chest pain and after what I believed to be the usual assumption of indigestion, asked my wife to drive me to a cardiac centre, fortunately only four miles away, where I had a single stent inserted in the left anterior descending very quickly. more…

I was born in the Borough of Partick and a couple of weeks ago watched Partick Thistle, or “Partick Thistle Nil” as they are affectionately called, for the first time for fifty years. Little had changed, with the exception of the availability of a “skinny” mutton pie on the half time menu. The competition, versus Hamilton Accies, was intense. The players committed, and the supporters were loyal. more…

Is care for people with rheumatoid disease better in Liverpool or Manchester?
Is care for frail elderly people better in Somerset or Devon?
Which big city has the best service for people with bipolar disorder? more…

“The most effective screening programme ever,” this was Richard Doll’s gentle jest when I was director of national screening programmes. Aware of my efforts to ensure that screening did much more good than harm, using every improvement technique I could learn from IHI, Toyota, and wherever, he would point out that the auscultation of the heart of young recruits in the first world war led to large numbers of them being deemed to be unfit for the front because of a sign we now know to be without pathological significance – a systolic murmur. more…